As people are learning how to navigate life after hunkering down for more than two months in lockdown, there is a deep sense of fear.
Many in Bangladesh, just like in the rest of the world, want to return to the lives they had before the pandemic. They cautiously feel their way to an uncertain future. Along the path, there is grief. There is also hope.
To make sense of the great unknown, bdnews24.com reported, it met remotely with Dr Bardan Jung Rana, the WHO representative to Bangladesh. During the meeting, the news agency says, a careful balance between saving lives and saving livelihoods is a piece of advice that stands out.
Rana has urged the people and the government to take responsibility for suppressing the COVID-19 crisis at the individual, community and national levels as lockdown curbs are eased.
Bangladesh, one of the most densely populated countries, with one in four people still living in poverty, faced particular challenges in dealing with the worst public health crisis. And there is a threat that more people will slip back below the World Bank-defined poverty line as the pandemic casts a long shadow on the once-thriving economy. Dire forecasts emerged amid weaker domestic demand and a sharp decline in exports and remittances. Without the resources to support the new armies of the unemployed, closing the economy further would probably lead to more hunger and death.
“There is a lot of movement of people and social distancing is not as feasible due to the level of daily wages and the threat to livelihoods,” Rana said in an exclusive interview on June 02.
Unlike other richer countries, Bangladesh cannot take large-scale measures to provide for the livelihoods of its people, he said, which adds to the difficulty of coping with the virus.
The administration led by Prime Minister Sheikh Hasina decided not to extend the lockdown beyond May 30, but kept some restrictions in place amid surging COVID-19 cases that topped 55,000. To cushion the impacts of the pandemic, the government rolled out a social protection and economic stimulus package crossing Tk 1.0 trillion or 3.7 per cent of the country’s GDP. The government also borrowed $1.68 billion in loans, including $732 million from the International Monetary Fund, to tackle the fallout from the disease.
But the balance between lives and livelihoods in a crisis like the coronavirus outbreak is a difficult and painful choice for the government.
“Will it be difficult? Yes, it will be difficult. What it boils down to is how people are going to be handling this and how the government is going to ensure that people are taking responsibility,” Rana said.
The government must work to ensure that situations can be handled at the local and community level but individuals can also play a significant role in limiting the spread of the disease, he added.
“If people like you and me protect ourselves and concentrate on taking all the measures recommended to protect ourselves and everyone else protects themselves, the virus will not have a place to go.”
Since joining the WHO’s offices in Dhaka in December 2017, Rana found the pandemic to be the most challenging to deal with. A Nepali national, Rana is a medical doctor and has done his post-graduation in tropical medicine and hygiene at London University before completing his master’s degree in public health from the National University of Singapore.
In the interview, he was keen to stress the WHO’s understanding of the need to ease lockdown restrictions because of people’s financial needs despite the agency’s primary focus on public health.
“It has been two months already. We need to look into a gradual transition away from certain restrictions. We really need to carefully balance the socioeconomic benefit with the epidemic risk. The epidemic risk still exists,” Rana said of the relentless upward curve in viral infections since the first cases were detected in Bangladesh on Mar 08. The death toll went past 700, signalling a grim future.
The lifting of physical distancing regulations will mean an increase in cases, he said, pointing to the record number of cases detected in the past few days.
Countries across the world are struggling with these decisions, not just Bangladesh, Rana reminded. "The longer it goes on, the more livelihoods are affected. All UN agencies are concerned about how to balance this."
While the WHO focuses on the health aspect of the pandemic, analysing how the response can be strengthened and maintained as the lockdown eases, agencies like the ILO are trying to help governments determine how to reopen.
“We are supporting every government in the world to maintain the balance of saving lives and saving livelihoods," Rana said.
For daily errands, Rana advised the people to go by the book. “If you are going out to a shop, make sure you wear a mask and you keep your hands clean, limit contact and maintain physical distance. Avoid large gatherings. Don’t organise them either. If a meeting can be held over the web, do it. We need to adopt a new norm in order to live and resume socioeconomic activities but balance out the risk at the same time.”
These health precautions must be understood by everybody so that the changes in behaviour necessary become a matter of habit.
“If everyone contributes, I think we are moving in the right direction.”
Supporting network and supply chain
Since the early stages of the pandemic, the WHO, the UN and its development partners have been supporting the government’s preparations and response to the COVID-19 crisis, Rana said.
“As soon as the WHO announced that this was an international public health emergency, we began advising and supporting the government on how to deal with it.”
The support from these agencies included providing PPE and testing kits, training health workers, increasing the testing and treatment capacity of the country, scaling up communication at the community level and engaging communities so they can fully understand the situation and take the necessary measures, he said.
In addition, the WHO aided the quarantine control of confirmed cases, strengthening health systems and outlining guidelines and best practices to suppress the spread of the disease.
The WHO’s international supply chain also helped Bangladesh and other countries. “What the UN agencies have done is set up a global supply chain. Instead of each country having to go and buy from manufacturers individually, the agencies and their partners purchase necessities through a central system and then countries can go to them for supplies.”
The WHO is also helping to set up local manufacturing for required goods and maintaining proper quality control measures.
Asked whether Bangladesh would be able to control the steadily rising number of cases, the top WHO official in the country said it had already taken significant steps since the coronavirus came here.
Bending the curve
“As of mid to late March there was only a single laboratory capable of administering tests, now there are 52 across the country performing 10,000 tests a day with plans to expand further.”
Though the scale of the operation is not yet up to the needs of the situation, efforts are underway to address the issue, Rana said. “There are plans to increase the capacity of the labs, not only by adding more labs but expanding the number of tests a single lab can perform through human resources, equipment and capacity building.”
In Bangladesh, some only perform 180-200 tests a day now, but they are trying to double it or triple it. There are labs that can do about 800 tests a day. “There is a plan. They are working on it.”
The government is adding human resources, medical facilities and increasing capacity, but the scale of the response still needs to be extended, he said.
“Are we there yet? No. The number of cases is still going up and it will continue to go up, but we are slowly trying to bend the curve.”
“We must ensure that we perform contact tracing to detect cases as fast as possible, implement proper isolation of these cases, increase the testing capacity and increase the health capacity for treatment. These are the four areas that must continue to strengthen.”
Optimistic, but cautious of a cure
One advantage of the global nature of the pandemic, the WHO representative said, was that the entire world was working towards curbing the impact of the disease.
“All these large and wealthy countries are going through the same thing and suffering similar outcomes, so everybody is putting the effort to fast-tracking whatever they can get.”
This means people are working to get vaccines or other medicines that help in case management to people as fast as possible, according to him.
Rana said he was optimistic about the medicines being developed because so much work was being done involving different countries, different trials and different non-medical interventions.
The WHO is observing these tests and seeing which ones have the best outcomes that are the most effective and have the best outcomes with the least side effects, he said.
They are also administering solidarity trials involving several countries, a group which Bangladesh plans to join soon.
“So there is a lot of work being done right now and yes I am very positive that we can achieve something,” Rana said.
“If you remember, in the case of a number of the big outbreaks, even Ebola, we ended up with a vaccine, but before that we found various innovative ways to suppress the disease. Work is being done on those as well and I am very optimistic that we will come through.”
Asked whether the WHO approved the use of potential COVID-19 drugs such as remdesivir developed by Gilead Sciences Inc in the US and copied by some drugmakers in Bangladesh, Rana was more reticent and stressed the need for proper clinical trials and study.
“The main concern is what happens if it doesn’t work. All the drugs available on the market have a lot of research done on them. Trials have been done, papers have been written on them, their possible side effects and complications.”
“We don’t have that with these medicines. The WHO is currently saying that we should not administer these drugs as treatments or prophylactics.”
At this moment, without having the complete evidence in hand, the WHO discourages their use for treatment, but says it can be used for a clinical trial.
“For the sake of clinical trial, you can start in a very controlled way and say here is what the outcome is. Everyone is trying to contribute to this,” Rana said. “The clinicians who are very well versed about this are taking all the precautions that are necessary.”